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Abordaje Laparoscópico En El Tratamiento De La Colecistitis Aguda: Estudio Retrospectivo En 609 Casos

B. Navez, Mara Arenas, D. Mutter, M. Vix, David A. Lipski, E. Cambier, P. Guiot, J. Leroy, J. Marescaux
Published 2003 · Medicine

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Resumen La colecistectomia laparoscopica (CL) es actualmente bien aceptada como el tratamiento de eleccion en la colelitiasis sintomatica no complicada. La aplicacion de la tecnica laparoscopica en pacientes con colecistitis aguda (CA) es mas controvertida. El exacto papel y los beneficios potenciales de la CL en el tratamiento de la CA no se han establecido claramente, ni existen amplias series clinicas. El objetivo del estudio fue valorar la aplicabilidad, seguridad, beneficios y complicaciones especificas del abordaje laparoscopico en pacientes con CA. Se realizo un analisis retrospectivo de los pacientes admitidos en dos unidades de cirugia digestiva de urgencia entre octubre de 1990 y diciembre de 1997. Se identificaron y evaluaron 609 pacientes que cumplieron los criterios de CA. La tasa de complicaciones fue del 15%, con 12 fistulas biliares postoperatorias (1,97%) y 4 lesiones de la via biliar (LVB) (0,66%). La mortalidad global fue del 0,66%. Las complicaciones locales y globales se correlacionaron significativamente con el retraso entre el inicio de los sintomas agudos y la cirugia, pero no asi la tasa de complicaciones generales ni la de fallecimientos. Nuestros resultados demuestran la seguridad y la factibilidad de la CL en la CA. La colecistectomia temprana dentro de los primeros 4 dias se recomienda ampliamente para minimizar las complicaciones e incrementar las posibilidades de un sabordaje laparoscopico con exito.
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